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Brain volume loss is an important marker for assessing atrophy and disability in MS patients. However, the contribution of gray and white matter to whole brain volume loss in MS warrants further examination. Additionally, there is a need to identify markers to assess the effectiveness of known disease-modifying treatments so that MS patients can receive optimal care.

Brain atrophy measurements, both global and regional (whole and partial), assess net tissue damage, reflecting the sum of demyelination — damage to the protective coat (called myelin) that surrounds nerve fibers — and injury and loss of brain cells. Global brain atrophy has predictive importance for MS disease progression, while regional brain atrophy is a more sensitive and reliable indicator of disease status.

Common symptoms in patients with neurological conditions are poor posture, balance instability, and compromised gait. From an increased likelihood of falling to reduced independence, compromised motor function and stability can lead to a range of issues that have a negative impact in these patients and their families, emotionally and economically.

Research has shown that sensory stimulation of the feet can improve dynamic stability.

If multiple sclerosis symptoms make you head to the bathroom more often than you'd like, try some simple tips that can help you take charge of your urge to go.

Don't sip. Drink a small glass of water (about 6 to 8 ounces) all at once every few hours during the day. That's better than sipping drinks constantly, which might make you want to pee more often. You'll know when you get enough to drink because your urine will turn light yellow.

Stop drinking before bed. Stay hydrated, but don't drink too close to bedtime or you could wake up during the night to use the bathroom. Have your last drink of water or other fluid at least 2 hours before you go to bed.

Limit caffeine and alcohol. Cut back on coffee, soda, beer, and wine. Caffeine and alcohol can irritate your bladder and increase the urge to go. Alcohol also affects the way your kidneys absorb water, and it can make your bladder fill up more quickly than usual.

Don't smoke. Nicotine is another bladder irritant. If you smoke, ask your doctor for advice on nicotine replacement products, medicines, and other methods to help you quit.

Do Kegel exercises . Just like you tone your biceps and triceps, you can strengthen the pelvic floor muscles that support your bladder. These muscles hold urine in your bladder so it won't leak when you sneeze, cough, or laugh.

To find the right muscles, squeeze like you would to stop the flow of urine, hold for about 4 seconds, then release. Do these exercises a few times each hour. You don't have to set aside a special place or time. Do them wherever and whenever you like.

If you have trouble finding your pelvic floor muscles, ask a nurse or physical therapist for help.

Retrain your bladder. Go to the bathroom on a regular schedule, such as every 2 hours. Do it even if you don't feel like you need to. That way you'll prevent your bladder from filling up too much and overflowing.

If you feel the urge to pee before the full 2 hours are up, try to hold it in for just 5 minutes more by tightening your pelvic floor muscles. Over time, you should be able to have longer and longer periods of time between bathroom visits.

Due to rules that restrict access and require patients to cover more of the cost, those without low-income subsidies can expect to spend almost $6,900 a year out of pocket for MS medicines, researchers reported.

"It's a dysfunctional market that lacks the typical incentives for most other consumer products," said lead author Daniel Hartung. "Aside from the public optics, there are few incentives for companies not to raise prices. Most intermediaries in the drug distribution channel, including drug companies, benefit from higher prices."

Hartung is an associate professor at the College of Pharmacy of Oregon Health and Science University (OHSU) and Oregon State University.

MS is an unpredictable disease of the central nervous system, resulting in symptoms that include vision problems, muscle weakness, tremors and difficulty with balance and coordination.

Out-of-pocket drug costs are often tied to undiscounted list prices, and there appears to be a link between rising prices for MS drugs and more use of restrictive policies by Medicare drug plans, according to the researchers.

For example, they found that patients who are prescribed the only generic drug in one class -- glatiramer acetate -- will pay more out of pocket than patients using any brand-name drugs in the same class.

Medicare rule changes last year were meant to reduce patients' out-of-pocket costs through increased discounts from brand-name drug manufacturers. But the change resulted in higher out-of-pocket costs for users of certain generic products.

"This is a pernicious effect of the release of a generic and an unfortunate effect of Medicare rules," study co-author Dr. Dennis Bourdette said in an OHSU news release. Bourdette is chairman of neurology at the OHSU School of Medicine in Portland.

A Trump administration proposal to address this incentive disparity between brand-name and generic drugs could reduce patients' total out-of-pocket spending, according to the researchers.

"Despite increases in the number and diversity of disease-modifying therapies for MS, prices have risen rapidly over the past two decades," Bourdette's team wrote. "The rise in high coinsurance cost-sharing models, coupled with escalating drug prices, means that patients will increasingly face prohibitive out-of-pocket spending."

The study appears in the February issue of the journal Health Affairs.

Friday, February 22, 2019

Two newly identified variants of the known pharmaceutical agent chloroindazole showed significant anti-inflammatory and neuroprotective benefits in a mouse model of multiple sclerosis, a new study shows.

Multiple sclerosis (MS) is an autoimmune, demyelinating disease of the central nervous system with no known cause or cure. Patients with MS characteristically show loss of the myelin sheath, a protective coat in nerve cells that helps increase cell-to-cell signaling.

Several studies have suggested that estrogens — a type of hormone — are beneficial to the functioning of the central nervous system, and help regulate the immune system. Thus, they are attractive candidates for the treatment of MS.

However, despite their potential to treat MS, estrogen-based therapies can have several undesirable side effects, such as feminizing male recipients and increasing the risk of developing breast and endometrial cancers in females.

Interestingly, estrogens work by binding and activating two different types of receptors: the estrogen receptor (ER)α and ERβ. The cancer-inducing effects of estrogens are mediated mainly through estrogen receptor ERα. Hence, therapies that specifically target ERβ can bypass these deleterious effects.

Chloroindazole (IndCl), a pharmaceutical agent, has up to 100-fold relative binding affinity for ERβ over ERα. IndCl has been shown previously to have beneficial effects on modulating the immune system and the central nervous system, and inducing myelination of nerve cells in mouse models of MS.

The U.S. Food and Drug Administration (FDA) has warned against the use of plasma transfusions from young donors to alleviate or treat the symptoms of multiple sclerosis or other diseases, noting such transfusions have no proven clinical benefit and carry known health risks associated with their use.

Plasma is the liquid component of blood, containing proteins that help in clotting, and can be used to treat bleeding disorders and cases of trauma.

But its use in transfusions as a means of treating conditions ranging from multiple sclerosis, dementia, Alzheimer’s,Parkinson’s, heart disease and post-traumatic stress disorder are of concern, the FDA said in issuing its statement of Feb 19.

“We have significant public health concerns about the promotion and use of plasma for these purposes,” the FDA statement reads. “[W]e’re alerting consumers and health care providers that treatments using plasma from young donors have not gone through the rigorous testing … [necessary] to confirm the therapeutic benefit of a product and to ensure its safety.”

Scott Gottlieb, the FDA’s commissioner, and Peter Marks, director of its Center for Biologics Evaluation and Research, jointly issued the statement cautioning healthcare providers and the public that plasma infusions — being done at “a growing number of clinics” in several U.S. states — are not an FDA-approved or recognized treatment for aging, memory loss, multiple sclerosis, or other diseases.

“Our concerns regarding treatments using plasma from young donors are heightened by the fact that there is no compelling clinical evidence on its efficacy, nor is there information on appropriate dosing for treatment of the conditions for which these products are being advertised,” the statement notes.

According to the FDA, large volumes of plasma might be also be needed for such transfusions and that volume can pose significant risks, including allergic reactions, infections, and heart and respiratory problems.

Thursday, February 21, 2019

Experts stress the importance of
protecting adults with chronic health conditions from influenza

The recommendations in this Call to Action are based on
discussions at a July 2018 Roundtable convened by the National Foundation for
Infectious Diseases (NFID). The multidisciplinary group of subject matter
experts gathered to discuss the underrecognized burden of influenza (flu) on
adults with chronic health conditions, the connection between inflammation
caused by influenza, and the resulting exacerbation of common chronic health
conditions. Discussions focused on recommendations and strategies to protect
vulnerable populations by emphasizing the benefits of flu vaccination to
overall health, mitigation of illness severity and flu-related complications,
and improved patient outcomes.

These individuals are at increased risk of flu-related
complications and exacerbation of underlying disease, even when the condition
is well-controlled, due to the effects of flu-related inflammation that may
occur long after acute infection. Unfortunately, flu vaccination coverage rates
remain suboptimal in adults, partly due to a lack of confidence in vaccine
efficacy. However, strong evidence exists to support the benefits of flu
vaccination in mitigating disease severity, reducing hospitalization rates, and
disrupting viral transmission. There is an urgent need to raise awareness of
both the dangers of influenza infection and the benefits of vaccination in
adults with chronic health conditions.

Connection Between
Influenza and Exacerbation of Chronic Health Conditions

Nearly 50 percent of US adults age 45-64 years1 have two or
more chronic health conditions (Figure 1).2,3 As the US population ages, the
proportion of adults with chronic health conditions will likely rise, as the
prevalence of many chronic health conditions increases with age.3,4 The high
proportion of adults with chronic health conditions is of particular concern
due to the potentially serious interaction between influenza virus and certain
chronic health conditions, including heart disease, lung disease, and diabetes.
Flu can exacerbate these conditions and may increase the risk of persistent
catastrophic disability.

SYMPTOMS of MS

In multiple sclerosis , damage to the myelin in the central nervous system (CNS), and to the nerve fibers themselves, interferes with the transmission of nerve signals between the brain and spinal cord and other parts of the body. This disruption of nerve signals produces the primary symptoms of MS, which vary depending on where the damage has occurred.

Over the course of the disease, some symptoms will come and go, while others may be more lasting.

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